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• ~UIL®IIVG ~ERIVIIT <br />' Jurisdiction of ~ S <br />~Ipplicant to comp/ete numbered spaces only. d <br />dos ADDR [SS //A ~/J^ u <br />//Y /- v /~ <br />LOT NO. ~~ eLR TRACT <br /> <br /> <br />1 LEGAL <br /> <br />DESCR .. .. ............ <br /> <br />• .... ........ . ........~.. .. ... <br />~3[[ ATTACN[D SHEET) ...~ <br /> <br />1 <br /> . q <br />t ::i:.. :~ <br />1~: •~:•j. . <br /> OWN .. .. .. .. ...... ... MAIL ADDRES! _. ....... . . .. ZZIP .. .PHONE .. .. ... .. ~ <br />..- . .. NTRACroR -• .. -.. _. ...._ . ._ .. __..._. <br />MAIL woDRCSS ~ <br />••••• PNON[ <br />REGISTRATION NO. '~' <br />"- <br />' <br /> g <br /> • AR CNI TECT OR D[lI GN ER _ ..• .• ••• .• .••••---.•-•~ MAIL AODRE93• ••-•-• ••• •• •••••• PHONE ••• ~ •-•~ REGISTRATION NO. •-" •'•'--• -•-~ -i <br /> 4 <br /> EN6INELR _ ...... ... ....._.. _ _ ._... .... _ .. MAIL woDREes•••••••-~ •--•-••• ~• PNDNC ••• ~ ~ ••REGISTRATIONNO. •' "- <br /> 1 <br />i <br /> LENDER. ._.__ __.. _~ ._. _._-.. _.__. MAIL ADDR [a3 -.•.._..~ .... .. ._._.. ..._~.. .. .. ._ .._____. .. . eRANCN .• -•. .. •_ <br />_. ~ <br />. <br />. <br />. c , ` <br />~- YSE OF eU1LDING .. ___.. __. ... ._... _ ..._.. ..•_.... ......_.. ~ <br />..._ ... _ ........ <br />... ... _.._ .. <br />.- .. <br />.. ... <br />.... _.. .. ... <br />_ <br /> 7 : <br /> 8 Class of work: ^ NEW ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE ! <br />~. <br />9 ._. _. .....__. <br />Describe work: _; _. .__. _...... ... ... ._.__L_..._.._.. ...----.... .. <br />' ~ <br />~ //_ . r <br />~ <br />, _ <br />' " .. • : ~ ".~ <br />_'_ <br />- <br />• t <br /> V ^ <br />tv <br />1 ~ <br />< S <br /> <br /> <br /> .. .;,,.•. ,,.1~ ~ <br />10 Valuation of work: $ ~~ /~~' ~ e PLAN CHECK FEE <br />5P L ONDITIONS: ~.J V <br />Type or <br />•Q J' /h. ~ /S/t.!!77/tea v s..% ~~ r P Const. <br /> it ~ <br /> APPLIGA 710N ACCEPTED aV. vLgNS CHECKED aT: APPROVED F 1 DANCE ne <br /> • No. of <br /> Dwelling Units <br /> N O T I C E ~ Special Approval <br /> SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB- ZONING <br />• LNG, HEATING, VENTILATING OR AIR CONDITIONING. <br /> <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- HEALTH DEPT. <br />.• STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN B FIRE DEPT. <br /> MONTHS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR <br /> <br />ABANDONED FOR A PERIOD OF 6 MONTHS AT ANY TIME AFTER SOIL REPORT <br /> WORK IS COMMENCED. oTHER (speciry) <br /> 1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT <br /> . <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO ~IVE AUTHORITY TO VIOLATE OR CANCEL THE' <br /> PROVISIONS O ANV OTHER STATE OR LOCAL LAW REGULATING <br /> CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />ZED AG[NT <br />PERMIT FEE <br />Occupancy <br />Group • <br />Dlvlsion <br />No. or <br />stories Max. <br />Occ. Load •• ' <br />Use <br />Zone Fire Sprinklers <br />Required ^Yes ^NO <br />OFFSTREET PARKING SPACES: <br />Covered Uncovered ~ ~ - .•~' `• • <br />Required Received Not Required <br /> <br />O <br />SIGNAT RE O OWN it OWNER eU IL D[R (DATEI • <br />WHEN PROPERLY ALIOATED fIN THIS SPACE) THIS IS YOUR PERMIT <br />PLAN CHECK VALIDATION cK. M.O. CASH PERMIT VALIDATION cK. M.o. CASH <br />r <br />Mt - ~ DCHIBi'i' R <br />